Alisa Brownlee, ATP, CAPS blog offers recent articles and web information on ALS, assistive technology--augmentative alternative communication (AAC), computer access, and other electronic devices that can impact and improve the quality of life for people with ALS.
Email--abrownlee@alsa-national.org.
Any views or opinions presented on this blog are solely those of the author and do not necessarily represent those of the ALS Association.

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Thursday, September 20, 2012

WASHINGTON — Wheelchair suppliers raised concerns Wednesday about a new government program that requires Medicare contractors to sign off before power wheelchairs can be delivered to elderly and disabled consumers.

Federal health officials countered that the changes are needed because nearly 80 percent of the power wheelchair claims submitted to Medicare don’t meet program requirements. That error rate represents more than $492 million in improper payments annually.

The new program began on Sept. 1 and requires providers in seven states to get confirmation from a government contractor that Medicare will pay for the device before they deliver it.
Michael Clark, general counsel for the SCOOTER Store, says the pilot project goes too far and every claim his business has submitted under the new program has been denied.

GOP members of the Senate Special Aging Committee called the hearing to learn how the pilot project was working. Sen. Bob Corker, R-Tenn., said that television commercials promoting wheelchairs give him the impression that the companies would figure out some way for the government to foot the bill if customers would only inquire.

“I think most Americans have seen these advertisements on TV and probably question what the federal government is doing. I certainly do.”

Clark told Corker that only 13 percent of those who seek a power wheelchair end up getting one. He said the idea that the company is simply trying to sell as many chairs as it can regardless of merit was incorrect.

The cost for the devices ranges from $1,500 for scooters to $3,600 for more complex power wheelchairs over the course of the rental period.

Under Medicare rules, power wheelchairs are covered only when patients need them for daily activities within the home and when canes, walkers or manual wheelchairs are considered as insufficient assistance.

Medicare will only pay after a physician meets with patients face-to-face and prescribes the wheelchair. A supplier recommends the type of wheelchair needed and also submits a claim to Medicare. Under the demonstration project, a doctor or supplier will submit a prior authorization request along with all relevant documents supporting Medicare coverage. The contractor then decides whether a request has met the requirements for coverage.

Medicare officials said such prior authorization is routinely required in the private sector. It does not add paperwork, but simply requires that documents be submitted earlier in the review process.
Stephen Peake, a medical director at Blue Cross Blue Shield of Tennessee, applauded the Centers for Medicare and Medicaid Services for the new program and that he would welcome it being used in Tennessee. He said if the program’s results mirror those with his company then it will result in significant savings for taxpayers.

Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Tuesday, September 18, 2012

Researchers have used a neural implant to recapture a
lost decision-making process in monkeys-demonstrating that a neural prosthetic
can recover cognitive function in a primate brain. The results suggest that
neural implants could one day be used to recover specific brain functions in
patients with brain injuries or localized brain disease.

The world at his fingertips: Alan Martin shares a joke with Jon Henley. Photograph: Christopher Thomond for the Guardian

I am sitting staring at a computer screen. So far so banal, except that this screen features a red dot that, by some technological magic, tracks the movement of my eyes: I can place it where I want on the screen just by looking. The bottom of the screen portrays a keyboard, although I could, if I chose, select other screens made up of various vocabulary, grammar and expression-based menus, which, for experienced users, would doubtless speed things up.

Because this is painstaking. I look at a letter, and the red dot sits on it. I continue staring, and the dot blinks, twice. The letter then pops up at the top of the screen. I move on to the next letter (or, more often, the backspace).

It gets easier: there's predictive text, like on a mobile phone, so I stare at the word I want, which gets added to my sentence. Eventually, the phrase is complete. I stare at it and it blinks. "What an amazing machine," says a cool, synthesised voice. "Rather let down by its user."

This is eye-gaze technology, at the leading edge of a fast-evolving and – for those who need it – vital field known as augmentative and alternative communication (AAC), plus the closely related assistive technology (AT). Without it, we would have been denied access to the remarkable mind of Professor Stephen Hawking (not to mention his starring role at the Paralympics opening ceremony). Nor would the locked-in syndrome sufferer Tony Nicklinson have been able to express so memorably – using eye-gaze – his despair at being refused the right to an assisted suicide. Hawking, with characteristic elegance, summarises its value: "Even more important than the freedom of speech is the freedom to speak."

Most of us know nothing about it. Worse, says Anna Reeves of the ACE Centre, a national charity that provides independent AAC assessments, advice and training, "a lot of people who need it have real trouble getting it. The funding's a mess. It falls between education and health, and most local authorities don't have specific budgets for it."

Yet AAC can be life-changing. Alan Martin, who developed cerebral palsy as an infant, was 31 before friends clubbed together to buy his first communication aid. "Before that," he explains in one of several pre-recorded messages he can activate on his current machine, "I relied on facial expressions and gestures. It was very frustrating."

Jovial and instantly engaging, Martin now runs his own company, Mouse on the Move, providing inclusive dance workshops for people with disabilities. To talk, and teach, he uses a wheelchair-mounted portable computer. He has reasonable control of his right arm, so uses a finger to press symbols on the screen that open up successive folders of images, words and frequently used phrases. He can also send emails and – an exciting new addition – text messages through a mobile phone connected to his computer. The whole system, Reeves says, cost around £8,000, and is in the middle of a spectrum of more than 100 different kinds of communication aids. ("Rubbish," says Martin succinctly, when asked what he thought of his first device.)

At one end are simple picture books and communication boards from which users select letters, words, phrases, pictures or symbols to communicate their message. Simple electronic devices contain digitised speech messages pre-recorded by a family member or carer and activated by a big button. More sophisticated boards hold up to 32 symbols and attached messages.

But helpful as these devices are, they are limited to pre-set messages. Computer-generated speech lets users say what they want to say. A portable machine called the Lightwriter has existed since the 1970s, allowing people who can type to display messages on a screen and also speak synthetically. More recently, says Reeves, "we've seen some great apps being developed for iPads and the like. If they work for you, they're brilliant. Especially for kids, because they're cool."

One, Proloquo2Go, even features a couple of authentic British children's voices, as well as "sad" and "happy" versions of the same voice; until recently synthesised speech robbed users of accent, emotion and intonation. Alan, who was born on Merseyside and is a huge Liverpool fan, would love to be able to speak scouse.

At the top end are the systems used by Martin, Nicklinson and Hawking: fully functioning computers, controlled in any number of ingenious ways. Hawking now uses a muscle in his cheek; another system moves the mouse through minuscule lip movement. These systems are capable of emailing, texting and even opening doors, turning on lights and operating the telly.

There are, Reeves says, perhaps 260,000 people in Britain using AAC equipment, about 10% of them using this kind of hi-tech aid. Their conditions range from serious physical and learning disabilities through sensory impairment to autism, motor neurone disease, stroke and, commonly, cerebral palsy. "There are also many who are undiagnosed, who simply present to us with an inability to communicate," she says. "It's far more common than people think."

Formed this summer by the merger of two separate charities to develop what would be, astonishingly, Britain's first national AAC/AT service, the ACE Centre holds open information days, carries out in-depth needs assessments on individuals, and advises and trains children and adults with AAC needs as well as teachers and carers.

But it doesn't have the money to provide actual aids for any longer than a short test period. Reeves wants to see a proper, secure, nationwide provision model that would ensure everyone in the country who needs communication aids gets them, preferably on long-term loan. "At the moment," she says, "we feel a bit like ladies in a sweet shop. We say: 'Look, this is all the lovely stuff available. Now fund it.' Which is wrong: communication is not a privilege, it's a fundamental right."